| NPI | 1518596600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X Radiology Radiation Oncology (Licence: VA 0101284021) |
| Additional Taxonomies | 2085R0001X Radiology Radiation Oncology (Licence: WV 34923) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2025-06-06 |